HC Deb 27 July 1955 vol 544 cc1308-18

Motion made, and Question proposed, That this House do now adjourn.—[Colonel J. H. Harrison.]

10.0 p.m.

Dr. Barnett Stross (Stoke-on-Trent, Central)

My purpose tonight is to draw attention to the problem of tuberculosis as it affects immigrants into Britain, and I hope to indicate, within the short time at my disposal, a little of the background of the problem, and what its size is, and to offer some suggestions of a tentative nature for an attack upon a disease that has so long ravaged mankind. This problem is one which is of universal, world-wide application, but I wish to confine myself to its application to ourselves and to those who, for one reason or another, come here to Britain, to our large towns and cities.

The problem in the main is of those who enter this country and who are of rural stock, for they have poor immunity against tuberculosis. They are peculiarly susceptible, especially those in the age group from 15 to 25, and many of them are in a tuberculin-negative state. They come to our great cities and large towns where the risk of infection is, of course, high and where the stress of adjustment to a new life is severe.

Some of us, and I am one, and for myself I apologise, have misunderstood the problem. It used to be thought that many of these immigrants entered the country already suffering from tuberculosis. This may be true of some, for we know that in Eire, for example, the death rate from tuberculosis is at present 1,500 per year, and that is a serious figure. However, the fact is, I think, now recognised that the majority of those coming here are free from tuberculosis and, not only that, are negative reactors. A high percentage of them are. They are descendants of people who had little or no contact either with human or bovine tuberculosis.

Accordingly, it is not surprising to find that they are more vulnerable to infection than the English, who were ravaged by this disease, mainly in the seventeenth and eighteenth centuries, and have, as a result, acquired some immunity. It is noted that a high percentage of the immigrants, especially of young Irish women, tend to develop pleural effusions and progressive primary lesions, and these are serious types of tuberculosis. I heard this morning that in the past five years, it is claimed in Eire, 1,300 Irish immigrants have returned there from this country to enter sanatoria there. That is some evidence of the size of the problem, for many others stayed here during those years to be treated in our own English or Scottish sanatoria.

The immigrants are by no means all Irish. There are immigrants from the West Indies and, to a lesser extent, from Africa, Cyprus, India and Malta. Some of them come here to study, but the majority come here to work; and many students have to work as well as study to be able to carry on their studies. From Ireland, I am advised, at present the number is approximately 20,000 per year. I should like to point out to the Parliamentary Secretary, though I am sure she is cognisant of it, that here has been a change in the type of immigrants in the last few years—more women as compared with the number of men, and more from rural areas and the West and South Coasts of Ireland. The numbers from the West Indies total about 10,000 a year, and of them I say no more at the moment than that they are less vulnerable because they belong to older age groups. However, we do not know very much about them. From other territories the numbers are far fewer.

In limiting my remarks to the Irish immigrants, my excuse is that it is of them that we know the most, and that is the only reason why I do so. I want to make it clear that the problem as it affects them is much the same in quality as it affects all others. It applies to people in Britain itself as they move about from one part of the country to another. The inhabitants of Wales, Northern Scotland, the Outer Isles, the Shetlands, face much the same danger when they come to our cities, especially if they come from rural areas. Their problem is much the same, and the solution of the problem which I am suggesting for the Irish or the West Indians should be considered for them too.

The following facts about the 20,000 who migrate to this country each year are significant. Firstly, the majority are females, I think about three to two and perhaps an even higher proportion. The great majority of them are in the 15 to 25 age group. About 90 per cent. come from rural Ireland, in the main from the western and southern coastal areas. The percentage of negative reactors is approximately 50. In some counties like Roscommon it is over 60 per cent., which is a very high figure showing that they have not been in contact with tuberculosis of any kind and have developed no personal active immunity.

They enter in the main the catering, clothing and building trades, mostly in London, Glasgow, Coventry, Newcastle, Manchester and Birmingham. The majority tend to live in lodgings and hostels when they first come here. To the factor of overcrowding there must be added the problem of overwork, owing to overtime working, because when people wish to establish themselves in any new country that is what they tend to do. Nearly all are married and most of them send money home.

In spite of a background of some poverty, they eat better on the farms in Ireland than they do in lodgings in this country during their first few months. By no means all break down and become infected but many of them do, and that is the thesis of my argument. When they are infected and they go back home they may unwittingly damage the health of their own families by infecting them. They may have also infected contacts in this country. In any event, whether here or in their own country, they reach a stage of hospitalisation, and hospitalisation is prolonged, as the Parliamentary Secretary to the Ministry of Health will agree and, for that reason, is very expensive.

We think now that, for the reasons I have given, native-born Irish tend to be more susceptible than the English or the Irish born in England, because immunity is quickly acquired in one generation where people are original negative reactors. It is significant that the death-rate from tuberculosis per hundred thousand in Liverpool and Glasgow, where many Irish go, is very high for the population as a whole. It is 57 and 72.7 whereas in Leeds and Bristol the rate is 37 and 38.

I am also told that in the North-West Metropolitan Region, the number of Irish who occupy beds which are devoted to the treatment of tuberculosis is one in nine as compared with one in seven for London-born people. When the population ratios are approximated, it suggests that three times as many Irish are being treated in these hospitals as London-born citizens. If that be at all true, although I am giving a sample from figures which are not very high, it would suggest that special care should be taken to prevent the disease in those who come from Ireland.

The Irish are very sensitive to the problem and they understand its gravity. I notice that in the "Irish Press" today there is a note stating that an appeal to young people is being made by the Ministry of Health there urging them that if they are going to live or work in towns and cities, either in Ireland or abroad, they should avail themselves of B.C.G. vaccination and mass radiography. That appeal was made last night. They understand the problem because they suffer from it, and they are undoubtedly doing their very best.

The purpose of my speech is to try to secure some liaison with our own Ministry, of an informal nature, so as to help these people both over in Ireland and when they come over to this country. The propaganda of St. Ultan's in Dublin of the need for B.C.G. vaccination for negative reactors if going abroad or into their own cities is excellent, but I am sure the authorities there would like to see it done on a very much wider basis. I do not think it should be difficult to evolve some loose machinery of an informal and voluntary nature under the guidance of the Ministry of Health which would give us liaison with the health authorities over there and in the other countries on which I will touch in a moment.

Before making tentative suggestions as to how this might be done, I want to urge one point. We must make it absolutely clear that under no circumstances whatever is there any hint of compulsion or restriction about anything we intend to do. I am sure the Minister of Health had that in mind when he answered me on Monday, and I absolutely and entirely agree with him. One way to spoil everything would be to suggest restriction or compulsion about the free entry or exit of the people whom I have in mind.

The tentative suggestions I have got are as follows. In the first place we should have a committee of representatives, principally medical, from both countries, which should be established at the suggestion of the Minister of Health in Britain. The functions of such a committee would be to consider, on the basis of the two countries being equal partners, means whereby tuberculosis in migrants would be prevented. That should be the first and primary consideration. A second function would be to consider means whereby tuberculosis, present or developing, in migrants should be detected and treated as early as possible.

Thirdly, we want effective liaison between the medical services of Britain and Ireland in this matter, with perhaps particular regard to the exchange of case records and X-rays of patients, if such are available. I think these will become more available in the future. Fourthly, there might be some means of collecting further information than there is already relating to this problem. Something has got to be done in Ireland, and equally something must be done here. I hope I shall give no offence if I make a few suggestions quickly.

I suggest that in Ireland there should be chest radiography and tuberculin testing of intending migrants, with B.C.G. vaccination of negative reactors. This should be left entirely to the Irish authorities. There might be established some central record office in Dublin, and it might be advantageous if a form of health record card could be devised and retained by the migrant. There should be means of contacting any intending migrants, and there should be careful examination and appropriate health propaganda to see that people do not slip through the mesh, because these young people have very little care for their health and we must recognise that when they are of that age one must think for them, as they are not always prepared to do so for themselves.

Migrants should be advised to attend at mass radiography units when they come to Britain, and they should do so at six-monthly intervals for the first two years. When they return to Ireland they should be advised to have radiography there for two years in order to make sure they are all right. Our part in Britain should be the antithesis to this. It should be primarily supervision of the health of the migrants, and I need hardly say the main point should be we should be able to find where they are, and those who have not a clean record should have the services made available for them here. I would plead that liaison officers of Irish nationality should be made available in the great cities where these people tend to go in great numbers, so that they can be followed up at their place of work, worship and entertainment to make sure none of them neglect themselves.

For the West Indies, Cyprus and the African Colonies the technique would be the same, but it would mean that we should have to bring in and consult with the Colonial Office, the Commonwealth Relations Office, the Home Office and local authorities, as well as medical and social welfare workers. If such a committee be formed, I hope that the trade unions and employers will be consulted.

To revert to the Irish question, think what great help could be given to such a committee by the great employers of labour, such as McAlpines, with their recruiting offices in Cork and Dublin. In the cities where the problem is most grievous there should be a concentrated diagnostic campaign in order that nobody who needs attention and care should be missed. The special occupations I have mentioned—clothing, building and catering—should be subjected also to a diagnostic survey. Perhaps the Minister, who has now the necessary power, would consider ultimately a pre-employment X-ray and tuberculin test for all employed in the handling of food and drink, particularly when they are working in catering establishments.

I apologise for rushing this speech and I am very conscious of the fact that I have only been able to touch the fringe of a great and world-wide problem. Tuberculosis, as we know it, has afflicted mankind ever since urban life commenced on this planet. Ever since then the youth from the countryside has poured into the towns and cities all the world over to become grist in the mill of this deadly plague. Today, for the first time, we have the knowledge and the means to halt the assault of tuberculosis on these people, and I am sure that we have the will. I know that the Parliamentary Secretary agrees that something can be done and will be done.

Lastly, may I express my thanks to those who work in medicine and to whom I am greatly indebted for the little knowledge that I myself possess.

10.17 p.m.

The Parliamentary Secretary to the Ministry of Health (Miss Patricia Hornsby-Smith)

The House knows very well the genuine interest the hon. Member for Stoke-on-Trent, Central (Dr. Stross) takes in the problem of tuberculosis. I am grateful to him for the broad terms in which he has dealt with this problem among immigrants, because there has been a measure of publicity on this matter and I should like to take the opportunity to clarify the position of the Ministry on one or two items. The hon. Gentleman brought forward two main points: the threat of the infected immigrant and also the position of the susceptible immigrant who comes here in an unprotected state and succumbs later to the hazards of urban life.

So far as a temporary immigrant is concerned, the interest of this country, and indeed of the country of origin, is identical and there is no conflict between us in our desire to help to eradicate this disease. However, it is obviously difficult to pick out any selected group of nationals for special treatment which would entail either statutory measures or, alternatively, focussing attention on those nationals as against preventive measures for the rest of the community.

I want particularly to bring this problem into proper perspective in relation to the incidence, the control and the cure of the disease now operating in this country, because I would not like it to be thought that this was a problem which was seriously jeopardising our record in development against tuberculosis or that it was of a magnitude to cause grave harm to the progress we have made.

I think it fair that I should give the House a few figures to get the matter into proper perspective. The overall mortality from the disease—the immigrants are included in the country's figures—has dropped dramatically in the last 30 years, having fallen from 58,000 to 26,000 between the wars and since 1939 to 8,000, a very remarkable result. Despite the very intensive efforts that we have made by mass-radiography to seek out as many new cases as possible, notifications, which include many of the immigrants, dropped from 52,000 to 42,000 between 1948 and 1954, and we are now engaged in an active drive still further to reduce the disease's toll. In all these measures, the immigrant, as a resident in the country, is equally concerned, and all the facilities of the health service are equally at his disposal.

Before dealing specifically with the Irish problem, I want to say a word about B.C.G. Frankly, we have been more cautious in our approach to B.C.G. vaccination than some other countries. At the moment, the Medical Research Council is carrying out widespread investigations into the long-term protection which it gives. The vaccine is available on an experimental basis for school children, contacts of tuberculosis patients and hospital staff if they have a negative reaction to the tuberculin test.

The hon. Member will know that we have 7,000 more beds for pulmonary tuberculosis than we had in 1948. Therefore, despite the immigrant problem, we have the disease well under control. We have better methods of detection, and despite that, far fewer cases are being recorded. Facilities and treatments are more widely available, and the preventive services, in which the immigrants share, are in an increasingly better position to take vigorous and effective action.

I wanted to make that point because I was anxious that undue publicity to the problem should not mislead the public into thinking that the whole progress of our tuberculosis campaign was in any way being halted.

Dr. Stross

I am grateful to the hon. Lady for giving way. I will not keep her a second. I am sure she is right, and if we had had an hour or two in which to deploy our arguments I should have brought that out strongly. However, the main thing is to prevent tuberculosis in negative reactors who are entering the country in large numbers.

Miss Hornsby-Smith

The hon. Gentleman has not left me much time. With regard to the immigration problem, it is true that health services and conditions vary from country to country, and where one country is getting to grips with and defeating the disease there is a certain appeal in the idea of a cordon sanitaire thrown round the country to prevent the entry of people who may be infected with the disease.

This aspect of the infected immigrant was brought to our attention by the Central Health Services Council which some two years ago was attracted by the idea that we should take action to ensure that people from abroad seeking work in this country should be free from the disease. I should like to deal with this aspect of the infected immigrant first.

The matter was, very rightly and properly, referred to the Standing Tuberculosis Advisory Committee, which definitely expressed the view that the position did not indicate a serious menace to the health of the country, and, on the basis of very special inquiries which were made, it was established that the number of immigrants entering with active tuberculosis was very small indeed. I realise that the hon. Member has to that extent agreed with me as he is more concerned with those who succumb to the disease after arrival.

I realise that the problem has been of particular concern to the North-West Metropolitan Regional Hospital Board because a quarter of the cases discovered in the survey were located within its region. Consequently, that board has a greater concern about the matter than the rest of the country. The majority of the cases are either Commonwealth citizens or citizens of the Republic of Ireland over whose entry into the United Kingdom there is no statutory control.

Therefore any measures to implement a health check on such citizens would involve legislation. We could check the very small minority of foreigners coming from abroad, but even that would mean the establishment at the 61 ports where there are already port health authorities of a new medical check in order to pass many thousands of people through a very fine net, with all the administrative problems and all the delay, to trace the very small number of infected people who might otherwise come in. We felt on balance, that this did not justify the vast administration that would be required, not to mention the difficulty of establishing what evidence we would consider acceptable from the various countries as a medical record of being free from the disease.

I turn to the question of those who come into the country and are susceptible because, as the hon. Member said, of changed conditions of their lives from rural to urban, and the strain of living in a new country. There is also the effect of a change of diet to urban from a rural farm diet. They may succumb to the disease. We have to be very careful not to exaggerate the numbers. A high percentage of those who come from Ireland are adolescent females, and to that extent they are the most susceptible of all the groups. We have to recognise that there is a conflict of view on the reason for their susceptibility. It is suggested that many of them come from the western counties and have not previously been exposed to tuberculosis infection, or that many of them have had minimal lesions which have broken down as the result of the strain.

The hon. Member made three suggestions, which were that there should be a committee, that measures such as X-rays and tests with B.C.G. should be taken before they leave Ireland, and that immigrants to the United Kingdom should be examined by mass radiography. We do not think that a permanent committee is necessary, because there is very close liaison between the officers of my Ministry and the Republic of Ireland. In the second place, it is clearly not for us to lay down what the Republic of Ireland should do on its side in the testing of immigrants.

On the question of a check there is very real difficulty. I was glad that the hon. Member was careful to say there must be no compulsion. To make special arrangements to examine one nationality of people who come here for employment would be far more likely to scare them off from taking the test than it would to encourage them to take it. The best method is that boards and local authorities which have this concentration of immigrants and are alive to the conditions in their area should deploy its mass radiography units so as to seek out the danger spots. The local authority should organise the general publicity and preventive medicine campaign so as not to single out this particular group and make it feel that it is being attacked as containing tuberculosis suspects, and so scare them off from taking any of the preventive measures, which we want everyone in the country to avail himself of.

The solution lies in close co-operation between regional hospital boards of areas where there is known to be a dense concentration of these people, and the medical officers of health and mass radiography units. We have more to gain in drawing these people in than by any specific attack on one set of nationals who, if they come here for employment, might well be deterred from taking—

The Question having been proposed at Ten o'clock, and the debate having continued for half an hour, Mr. DEPUTY-SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at half-past Ten o'clock.